Pressure injuries in patients receiving extracorporeal membrane oxygenation: a tertiary centre experience

Pressure injuries (PIs) are common in patients receiving intensive care and extracorporeal membrane oxygenation (ECMO). This study assessed the incidence and risk factors of PIs in patients receiving ECMO for COVID-19-associated acute respiratory distress syndrome (ARDS).

Patients who were admitted to the intensive care unit (ICU) with severe COVID-19-associated ARDS and received veno-venous ECMO between April 2020 and January 2022 were evaluated. All patients were monitored, evaluated and managed according to the Prevention and treatment of pressure ulcers: clinical practice guideline 2019. The risk for PI was evaluated using the Braden scale. Staging of PIs was made according to the National Pressure Injury Advisory Panel guidelines.

A total of 78 patients (median age 45 years) received ICU care and ECMO support. Of these, 75 patients were transferred to the ICU while on ECMO support; 24/78 (30.8%) patients already had PIs. New PIs developed in 24 patients (24/54, 44.4%) during prolonged periods of ECMO (median 48.5 days). The new PIs were mainly stage 2 (55%). The median time to new PI development during ECMO was 21 (range 4-60) days. The mortality rate was 32/54 (59.3%). In multivariable analysis, age (odds ratio (OR): 1.103, 95% confidence interval (CI): 1.022, 1.191; p=0.027) and ECMO duration (OR: 1.048, 95% CI: 1.016, 1.081; p=0.003) were independent predictors of PI development.

Strict compliance with the clinical practice guidelines for PIs by a dedicated ICU team may considerably reduce the incidence of PIs among patients receiving ECMO for prolonged periods.